Intracranial pressure monitoring in patients with acute brain injury in the intensive care unit (SYNAPSE-ICU): an international, prospective observational cohort study
2021; Elsevier BV; Volume: 20; Issue: 7 Linguagem: Inglês
10.1016/s1474-4422(21)00138-1
ISSN1474-4465
AutoresChiara Robba, Francesca Graziano, Paola Rebora, Francesca Elli, Carlo Giussani, Mauro Oddo, Geert Meyfroidt, Raimund Helbok, Fabio Silvio Taccone, Lara Prisco, Jean‐Louis Vincent, José I. Suárez, Nino Stocchetti, Giuseppe Citerio, Mohamed Abdelaty, Samia Abed Maillard, Hatim S. Ahmed, Lea Albrecht, Ali O. Al-sudani, Edgar Daniel Amundarain, S. Anand, Jens Bo Andersen, Montserrat Pujol Anglada, Yaseen M. Arabi, Irene Aragão, Maria Dolores Arias Verdu, Karim Asehnoune, Fernanda Boldrini Assunção, Gérard Audibert, Rafael Badenes, Tamanna Bajracharya, Pierluigi Banco, Danusa Cassiana Rigo Batista, Elisabetta Bertellini, Hedgar Berty Gutiérrez, Guillaume Besch, Patrick Biston, Aaron Blandino Ortíz, V. Blazquez, Summit Bloria, Chiara Bonetti, Piergiorgio Bresil, Iole Brunetti, Virginia Buldini, Anaïs Caillard, Italo Calamai, Marco Carbonara, Anselmo Caricato, Maria Chiara Casadio, Matías Casanova, Pedro Cavaleiro, M. Celaya Lopez, Chin-Pang Chan, Rajeev Chauhan, Raphaël Cinotti, Luisa Corral, Andrea Cortegiani, Antonella Cotoia, Ilaria Alice Crippa, Valery Davidovich, Sabatino Bianco, Chrysi Diakaki, Jamil Dibu, Aikaterina Dimoula, G. Domeniconi, Ligia J. Domínguez, N.Yu. Dovbysh, Paula Andrea Duque, Heidi Shil Eddelien, Anna Efthymiou, Thomas Egmose Larsen, Muhammed Elhadi, E. Favre Eva, Maria Fencl, Petra Forjan, Rafael Limeira de Freitas, Kristina Fuest, M. Fumale, Clément Gakuba, Laurą Galarza, Monique Ferreira Garcia, George Α. Lopez, Camilla Gelormini, Andrés Gempeler, Achilleas Giannopoulos, María Estrella Giménez, Aimone Giugni, D. Glorieux, Maria Isabel Gonzalez Perez, Primož Gradišek, Marina Grandis, Donald Griesdale, А. И. Грицан, Sarah Grotheer, Deepak Gupta, Elizabeth Hallt, Christopher Hawthorne, Raimund Helbok, Morten Olskjær Holm, Christina Iasonidou, Olufemi E. Idowu, Eleonora Ioannoni, A. Izzi, Manuel Jibaja, Prakash Kafle, Darshana Hewa Kandamby, Muhammed Khan, Sergey Khomiakov, Bram Kilapong, Jakub Kletečka, Klaudyna Kojder, Angelos G. Kolias, E. Kontoudaki, George Koukoulitsios, Nataša Kovač, Sergeja Kozar, Sandro M. Krieg, Pedro Kurtz, G. Kyriazopoulos, Massimo Lamperti, P. Lavicka, Luís Lencastre, Michael Levin, Roger Lightfoot, Anna Lindner, P. López Ojeda, Africa Lores, Marcelo B. Lucca, Ankur Luthra, Federico Magni, Birgitte Majholm, Demosthènes Makris, Frank Maldonado, Andrea Marudi, Safala Maskey, Liese Mebis, Jorge Mejía-Mantilla, Ray Mendoza, Nikola Milivojević, John-Paul Miroz, Berta Monleón, José María de las Heras Montes, Paola Morelli, Alessandro Motta, Eleni Mouloudi, Susanne Muehlschlegel, Silvio A. Ñamendys‐Silva, Gábor Nardai, Khadka Nilam, DaiWai M. Olson, Ahmad Ozair, Carlos Pacheco, J. Padilla Juan, Eleni Palli, Nidhi Panda, Nikolaos Pantelas, Laura Pariente, Douglas C. Pearson, Rodrigo Pérez-Araos, Edoardo Picetti, J.L. Pinedo Portilla, B. Pons, Federico Pozzi, Eva Provaznikova, M Quartarone, Hervé Quintard, Lalit Kumar Rajbanshi, Michael C. Reade, Samo Ribarič, Andrea Rigamonti, Luis Rivera, John Roberts, Yam Bahadur Roka, Oļegs Sabeļņikovs, Harsh Sapra, Stefan J. Schaller, Mypinder S. Sekhon, Walid Sellami, Ian Seppelt, Ainhoa Serrano, Kopal Sharma, Gentle Sunder Shrestha, Hoi‐Ping Shum, Sanderson Alencar Santos da Silva, Marcela Simoes, Sanjeev Sivakumar, Richard Siviter, Josef Škola, Mara Škoti, Margit Smitt, Rafael Soley, Romain Sonneville, Alessandra Soragni, Benjamin Soyer, Věra Špatenková, E Stamou, Eleonora Stival, Z. Olson, Krisztián Tánczos, C. Thompson, Jakob Edelberg Thomsen, S Tsikriki, Stijn Van de Velde, Walter Videtta, Federico Villa, Kamil Vrbica, Charikleia S. Vrettou, H Hoffmeyer, Stefan Wolf, Stefan Wolf, Sâmia Yasin Wayhs, Simone Maria Zerbi,
Tópico(s)Neurosurgical Procedures and Complications
ResumoSummary Background The indications for intracranial pressure (ICP) monitoring in patients with acute brain injury and the effects of ICP on patients' outcomes are uncertain. The aims of this study were to describe current ICP monitoring practises for patients with acute brain injury at centres around the world and to assess variations in indications for ICP monitoring and interventions, and their association with long-term patient outcomes. Methods We did a prospective, observational cohort study at 146 intensive care units (ICUs) in 42 countries. We assessed for eligibility all patients aged 18 years or older who were admitted to the ICU with either acute brain injury due to primary haemorrhagic stroke (including intracranial haemorrhage or subarachnoid haemorrhage) or traumatic brain injury. We included patients with altered levels of consciousness at ICU admission or within the first 48 h after the brain injury, as defined by the Glasgow Coma Scale (GCS) eye response score of 1 (no eye opening) and a GCS motor response score of at least 5 (not obeying commands). Patients not admitted to the ICU or with other forms of acute brain injury were excluded from the study. Between-centre differences in use of ICP monitoring were quantified by using the median odds ratio (MOR). We used the therapy intensity level (TIL) to quantify practice variations in ICP interventions. Primary endpoints were 6 month mortality and 6 month Glasgow Outcome Scale Extended (GOSE) score. A propensity score method with inverse probability of treatment weighting was used to estimate the association between use of ICP monitoring and these 6 month outcomes, independently of measured baseline covariates. This study is registered with ClinicalTrial.gov, NCT03257904. Findings Between March 15, 2018, and April 30, 2019, 4776 patients were assessed for eligibility and 2395 patients were included in the study, including 1287 (54%) with traumatic brain injury, 587 (25%) with intracranial haemorrhage, and 521 (22%) with subarachnoid haemorrhage. The median age of patients was 55 years (IQR 39–69) and 1567 (65%) patients were male. Considerable variability was recorded in the use of ICP monitoring across centres (MOR 4·5, 95% CI 3·8–4·9 between two randomly selected centres for patients with similar covariates). 6 month mortality was lower in patients who had ICP monitoring (441/1318 [34%]) than in those who were not monitored (517/1049 [49%]; p<0·0001). ICP monitoring was associated with significantly lower 6 month mortality in patients with at least one unreactive pupil (hazard ratio [HR] 0·35, 95% CI 0·26–0·47; p<0·0001), and better neurological outcome at 6 months (odds ratio 0·38, 95% CI 0·26–0·56; p=0·0025). Median TIL was higher in patients with ICP monitoring (9 [IQR 7–12]) than in those who were not monitored (5 [3–8]; p<0·0001) and an increment of one point in TIL was associated with a reduction in mortality (HR 0·94, 95% CI 0·91–0·98; p=0·0011). Interpretation The use of ICP monitoring and ICP management varies greatly across centres and countries. The use of ICP monitoring might be associated with a more intensive therapeutic approach and with lower 6-month mortality in more severe cases. Intracranial hypertension treatment guided by monitoring might be considered in severe cases due to the potential associated improvement in long-term clinical results. Funding University of Milano-Bicocca and the European Society of Intensive Care Medicine.
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